Open Access
Research
Cross-sectional study of patients with type 2 diabetes in OR Tambo district, South Africa Oladele Vincent Adeniyi,1 Parimalaranie Yogeswaran,2 Benjamin Longo-Mbenza,2 Daniel Ter Goon,3 Anthony Idowu Ajayi4
To cite: Adeniyi OV, Yogeswaran P, LongoMbenza B, et al. Crosssectional study of patients with type 2 diabetes in OR Tambo district, South Africa. BMJ Open 2016;6:e010875. doi:10.1136/bmjopen-2015010875 ▸ Prepublication history for this paper is available online. To view these files please visit the journal online (http://dx.doi.org/10.1136/ bmjopen-2015-010875). Received 16 December 2015 Revised 25 May 2016 Accepted 21 June 2016
For numbered affiliations see end of article. Correspondence to Dr Oladele Vincent Adeniyi; [email protected]
ABSTRACT Objectives: South Africa has pledged to the sustainable development goal of promoting good health and well-being to all residents. While this is laudable, paucity of reliable epidemiological data for different regions on diabetes and treatment outcomes may further widen the inequalities of access and quality of healthcare services across the country. This study examines the sociodemographic and clinical determinants of uncontrolled type 2 diabetes mellitus (T2DM) in individuals attending primary healthcare in OR Tambo district, South Africa. Design: A cross-sectional analytical study. Setting: Primary healthcare setting in OR Tambo district, South Africa. Participants: Patients treated for T2DM for 1 or more years (n=327). Primary outcome measure: Prevalence of uncontrolled T2DM. Secondary outcome measure: Determinants of uncontrolled T2DM (glycosylated haemoglobin (HbA1c) ≥7%). Results: Out of the 327 participants, 274 had HbA1c≥7% (83.8%). Female sex (95% CI 1.3 to 4.2), overweight/obesity (95% CI 1.9 to 261.2), elevated low-density lipoprotein cholesterol (95% CI 4.4 to 23.8), sedentary habits (95% CI 7.2 to 61.3), lower monthly income (95% CI 1.3 to 6.5), longer duration of T2DM (95% CI 4.4 to 294.2) and diabetes information from non-health workers (95% CI 1.4 to 7.0) were the significant determinants of uncontrolled T2DM. There was a significant positive correlation of uncontrolled T2DM with increasing duration of T2DM, estimated glomerular filtration rate and body mass index. However, a significant negative correlation exists between monthly income and increasing HbA1c. Conclusions: We found a significantly high prevalence (83.8%) of uncontrolled T2DM among the patients, possibly attributable to overweight/obesity, sedentary living, lower income and lack of information on diabetes. Addressing these determinants will require re-engineering of primary healthcare in the district.
INTRODUCTION South Africa has pledged to the sustainable development goal of promoting good health
Strengths and limitations of this study ▪ Primary healthcare study on glycaemic control in individuals treated for diabetes in a predominantly rural South African setting. ▪ Epidemiological data on patients and health system determinants of glycaemic control were explored. ▪ Owing to the cross-sectional design, the causal relationship with the determinants could not be ascertained. ▪ We were cautious with overgeneralisation of the findings, due to the convenience sampling of participants and under-representation of men in the study.
and well-being to all residents. While this is laudable, paucity of reliable epidemiological data for different regions on diabetes and treatment outcomes may further widen the inequalities of access and quality of healthcare services across the country. Diabetes, an incurable chronic non-communicable disease, imposes a significant burden on the health services and has become a global public health problem.1 2 Although diabetes was considered the disease of the affluent, however, a paradoxical shift in rural–urban lifestyles means that populations from low socioeconomic communities too are affected.3–5 According to the International Diabetes Federation6 estimates, 371 million individuals were living with diabetes worldwide in 2012, accounting for a prevalence rate of 8.3%. The prevalence of diabetes ranges from 4.3% in sub-Saharan Africa (SSA; lowest), 6.7% in Europe, 10.5% in North America and the Caribbean to 10.9% in the Middle East and North Africa (highest).7 About 2 million people are living with diabetes mellitus (DM) in South Africa alone.1 It is, however, projected that the number of individuals with diabetes will double in SSA over the next 20 years (110% absolute increase by
Adeniyi OV, et al. BMJ Open 2016;6:e010875. doi:10.1136/bmjopen-2015-010875
1
Open Access 2035),6 due to rapid nutritional and epidemiological transitions in the rural and urban communities.8 9 Going by the report of the International Diabetes Federation,7 SSA is ill prepared to deal with the astronomical increase in prevalence and incidence of diabetes and its complications in affected individuals. Despite the scientific discoveries in diagnostic and treatment modalities, it appears that treatment outcomes of individuals with confirmed diabetes are generally suboptimal in SSA. The prevalence of uncontrolled diabetes ranges from 62% in Nigeria,10 66.7% in South Africa1 to 79.2% in Uganda11 and 82% in Botswana.12 These figures are in agreement with the findings of Diabcare study which reported good glycaemic control in only 29% of treated individuals in six African countries.13 Several reasons have been advanced for the suboptimal glycaemic control of diabetes in SSA. Lack of an operational diabetes programme, inefficient healthcare systems, inadequate staffing, stock-out of essential drugs and lack of patient empowerment14 15 were highlighted as reasons for suboptimal treatment outcomes documented in the majority of African countries. Likewise, the high level of unemployment, poor access to health facilities, lack of knowledge about diseases, perceptions and practices, poor attendance and failure to keep appointments at diabetes clinics could have impacted the poor health outcomes in Africa.16 In addition, the total health expenditure for diabetes in Africa (
Research
Cross-sectional study of patients with type 2 diabetes in OR Tambo district, South Africa Oladele Vincent Adeniyi,1 Parimalaranie Yogeswaran,2 Benjamin Longo-Mbenza,2 Daniel Ter Goon,3 Anthony Idowu Ajayi4
To cite: Adeniyi OV, Yogeswaran P, LongoMbenza B, et al. Crosssectional study of patients with type 2 diabetes in OR Tambo district, South Africa. BMJ Open 2016;6:e010875. doi:10.1136/bmjopen-2015010875 ▸ Prepublication history for this paper is available online. To view these files please visit the journal online (http://dx.doi.org/10.1136/ bmjopen-2015-010875). Received 16 December 2015 Revised 25 May 2016 Accepted 21 June 2016
For numbered affiliations see end of article. Correspondence to Dr Oladele Vincent Adeniyi; [email protected]
ABSTRACT Objectives: South Africa has pledged to the sustainable development goal of promoting good health and well-being to all residents. While this is laudable, paucity of reliable epidemiological data for different regions on diabetes and treatment outcomes may further widen the inequalities of access and quality of healthcare services across the country. This study examines the sociodemographic and clinical determinants of uncontrolled type 2 diabetes mellitus (T2DM) in individuals attending primary healthcare in OR Tambo district, South Africa. Design: A cross-sectional analytical study. Setting: Primary healthcare setting in OR Tambo district, South Africa. Participants: Patients treated for T2DM for 1 or more years (n=327). Primary outcome measure: Prevalence of uncontrolled T2DM. Secondary outcome measure: Determinants of uncontrolled T2DM (glycosylated haemoglobin (HbA1c) ≥7%). Results: Out of the 327 participants, 274 had HbA1c≥7% (83.8%). Female sex (95% CI 1.3 to 4.2), overweight/obesity (95% CI 1.9 to 261.2), elevated low-density lipoprotein cholesterol (95% CI 4.4 to 23.8), sedentary habits (95% CI 7.2 to 61.3), lower monthly income (95% CI 1.3 to 6.5), longer duration of T2DM (95% CI 4.4 to 294.2) and diabetes information from non-health workers (95% CI 1.4 to 7.0) were the significant determinants of uncontrolled T2DM. There was a significant positive correlation of uncontrolled T2DM with increasing duration of T2DM, estimated glomerular filtration rate and body mass index. However, a significant negative correlation exists between monthly income and increasing HbA1c. Conclusions: We found a significantly high prevalence (83.8%) of uncontrolled T2DM among the patients, possibly attributable to overweight/obesity, sedentary living, lower income and lack of information on diabetes. Addressing these determinants will require re-engineering of primary healthcare in the district.
INTRODUCTION South Africa has pledged to the sustainable development goal of promoting good health
Strengths and limitations of this study ▪ Primary healthcare study on glycaemic control in individuals treated for diabetes in a predominantly rural South African setting. ▪ Epidemiological data on patients and health system determinants of glycaemic control were explored. ▪ Owing to the cross-sectional design, the causal relationship with the determinants could not be ascertained. ▪ We were cautious with overgeneralisation of the findings, due to the convenience sampling of participants and under-representation of men in the study.
and well-being to all residents. While this is laudable, paucity of reliable epidemiological data for different regions on diabetes and treatment outcomes may further widen the inequalities of access and quality of healthcare services across the country. Diabetes, an incurable chronic non-communicable disease, imposes a significant burden on the health services and has become a global public health problem.1 2 Although diabetes was considered the disease of the affluent, however, a paradoxical shift in rural–urban lifestyles means that populations from low socioeconomic communities too are affected.3–5 According to the International Diabetes Federation6 estimates, 371 million individuals were living with diabetes worldwide in 2012, accounting for a prevalence rate of 8.3%. The prevalence of diabetes ranges from 4.3% in sub-Saharan Africa (SSA; lowest), 6.7% in Europe, 10.5% in North America and the Caribbean to 10.9% in the Middle East and North Africa (highest).7 About 2 million people are living with diabetes mellitus (DM) in South Africa alone.1 It is, however, projected that the number of individuals with diabetes will double in SSA over the next 20 years (110% absolute increase by
Adeniyi OV, et al. BMJ Open 2016;6:e010875. doi:10.1136/bmjopen-2015-010875
1
Open Access 2035),6 due to rapid nutritional and epidemiological transitions in the rural and urban communities.8 9 Going by the report of the International Diabetes Federation,7 SSA is ill prepared to deal with the astronomical increase in prevalence and incidence of diabetes and its complications in affected individuals. Despite the scientific discoveries in diagnostic and treatment modalities, it appears that treatment outcomes of individuals with confirmed diabetes are generally suboptimal in SSA. The prevalence of uncontrolled diabetes ranges from 62% in Nigeria,10 66.7% in South Africa1 to 79.2% in Uganda11 and 82% in Botswana.12 These figures are in agreement with the findings of Diabcare study which reported good glycaemic control in only 29% of treated individuals in six African countries.13 Several reasons have been advanced for the suboptimal glycaemic control of diabetes in SSA. Lack of an operational diabetes programme, inefficient healthcare systems, inadequate staffing, stock-out of essential drugs and lack of patient empowerment14 15 were highlighted as reasons for suboptimal treatment outcomes documented in the majority of African countries. Likewise, the high level of unemployment, poor access to health facilities, lack of knowledge about diseases, perceptions and practices, poor attendance and failure to keep appointments at diabetes clinics could have impacted the poor health outcomes in Africa.16 In addition, the total health expenditure for diabetes in Africa (
